Heart failure with reduced ejection fraction (HFrEF) is a commonly seen clinical entity in the family physician’s practice. This clinical review focuses on the pharmacologic management of chronic HFrEF. Special attention is paid to the classification of heart failure and the newest recommendations from the American Heart Association concerning the use of guideline-directed medical therapy. β blockers, ACE inhibitors, ARBs, mineralocorticoid receptor antagonists are discussed in detail. The new emphasis on sacubitril-valsartan and SGLT2i’s as therapies for HFrEF are reviewed, followed by a brief discussion of more advanced therapies and comorbidity management.